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Home My WebLink About0020 GELDING CIRCLE - Health p Barnstable ° 297-0.51 I , °fB 's�, CERTIFICATE OF ANALYSIS Page: 1 of , Barnstable County Health Laboratory (M-MA009) ssgcHvsw Report Prepared For: Report Dated: 4/27/2012 Sally Desmond Desmond Well Drilling Order No.: G1267357 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 1267357-01 Description: Water-Drinking Water Sample#: Sample Location: 20 Gelding Circle Barnstable,,MA Collected: 04/25/2012 Collected by: Customer Received: 04/25/2012 Routine ITEM RESULT UNITS RL MCL METHOD# TESTED Nitrate as Nitrogen 0.64 mg/L 0.10 10 EPA 300.0 4/25/2012 Copper ND mg/L 0.10 1.3 SM 3111E 4/27/2012 Iron 0.14 mg/L 0.10 0.3 SM 3111B 4/27/2012 pH 6.6 PH AT 25C NA 6.5-8.5 SM 4500-H-13 4/25/2012 Sodium . 20 mg/L 1.0 20 SM 3111 B 4/27/2012 Total Coliform Absent P/A 0 0 SM9223 4/25/2012 Conductance 160 umohs/cm 2.0 EPA 120.1 4/25/2012 Sodium level is at the maxium contaminant level.- Those on a low sodium diet may wish to consult a physicians Attached please find the laboratory certified parameter list. Approved By: (Lab Director) ti7 5 Q a u PO ZZ ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level } Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 f Massachusetts Department of Environmental Protection f.31 Bureau of Resource Protection WELL DRILLER Please specify work performed: Address at well location: New Well Street-Number: Street Name: 20 a 1=GELDING GRCLE Please specify well type: Building Lot#: Assessor's Map#: Domestic Assessor's Lot#: ZIP Code: Number Of Wells: 51 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS r Yes r No North: West: 41.68940 70.29607 -� 1Su—bdiivisiontProperty/Desc'iption: I Mailing Address: r click here if same as well location addres Property Owner: Street Number:_ Street Name:' BRIAN SMITH GELDING GRGF City/Town: State: Engineering Firm: [iARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: R Yes 0 Not Required Permit Number: Date Issued: W2012 006 4/18/2012 Tr Massachusetts Department of Environmental Protection L1)z11 Bureau of Resource Protection-Well Driller Program Well Completion Reports(General) i Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Auger Choose Bedrock-- 1 WELL LOG OVERBURDEN LITHOLOGY From Drop In Extra fast or slow Loss or addition of To(ft) Code Color Comment (ft) drill stem drill rate fluid 20 Silty Sand Brown ( Ye r Fast Slow Loss r Addition F207 F407 Silty Sand —1 Brown r Ye r Fast Slow Loss Addition 40 50 Silty Sand 113rown Ye r Fast r Slow r Loss r Addition 50 70 Sil Sand Brown &CLAY ty Ye Fast r Slow Loss Addition 70 75 Sil 8 CLAY tY Sand Brown 0 Ye r Fast G Slow r Loss r Addition F757 F957 Fine To Coarse Sand I 113rown rJ Ye r Fast f3 Slow Loss 0 Addition 95 100 Fine To Coarse Sand Brown Ye Fast ro Slow Loss r Addition WELL LOG BEDROCK LITHOLOGY From Drop In Extra fast or slow Loss or addition of Visible Extra To(ft) Code Comment Rust Large (ft) drill stem drill rate fluid _ Staining Chips Choose CodeF 0 Ye to Fast r Slow r Loss r Addition Fr!—Ye r Ye ADDITIONAL WELL INFORMATION Developed 0)Yes 0 No Disinfected C:,Yes r W Total Well Depth 100 Depth to Bedrock _ Fracture c - Surface Seal Type Ne_ -- � Enhancement Yes r No CASING I 1Y_J Is Casing above ground From: 11 To: 10 From To Type Thickness Diameter Driveshoe 0� 96 Polyvinyl Chloride �� Schedule 40 Ye SCREEN No Scree From To - Type Slot Size Diameter 96 100 Stainless Steel Well Point 0.012 0 WATER-BEARING ZONES ❑DRY WEL From To Yield(gpm) 72 100 12 r Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(Genera) k I PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Horsepower Submersible Pump Intake Depth(ft) 95 Nominal Pump Capacity(gpm) 120 i` ANNULAR SEAL/FILTER PACK Water. From To Material 1 Weight Material 2 Weight Batches Method Of Placement (gal) Choose Material lChoose Material Choose One-- WELL TEST DATA G Time Pumping Time To Date Method Yield(gpm)• Pumped Level (ft Recovery(ft Recover BGS) (HH:MM) BGS) (HH:MM) 4/25/2012 Constant Rate Pump 12 1:00 76 0:01 72 WATER LEVEL Date Measured Static Depth BGS(ft) Flowing Rate(pm) 4/25/201 Z 72 12 ' 1 it I COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete a knowledge. Driller THOMASEDESMONDIII Registration# 7ti4 —� Monitoring[M] F7 Supervising Drill Firm DESMONDWELLDW Rig Permit# 023 Date Job Compl r NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. i j f, No.- -WA01A Fee---- ------------- BOARD OF HEALTH TOWN OF BARINSTAB LE Zippiication-for Well Congtructionjoermit Application is hereby made for a rmit to Constr t ), Alter ( ), or Repa' ( )an individual Well at: ovation — d f A sots Map and Parcel y _Gel \ _ _ � � -f � Owner ddr_s �.t��------- Installer — Driller Address Type of Building Dwelling _______------------____-- Other - Type of Building—= --__—__—._____ No. of Persons----.---_-_-- Type of Well �� \AL4\04-c,_- Ca acit Purpose of Well-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Signed — __ 1414117q d e Application Approved By— = a - te Application Disapproved for the following reaso : ____.------ — �— ------- — — date -- Permit No. - Issued--- - I _____—____—___.______ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Indlividual Well Constructed A, Altered ( ),.'or Repaired ( ) by�®e.Sw. _ _iU 'lr -------Inst -------------------- all1er ( � _ at—_ �Q-`�i!@, c& \= \N 31 6�L+------—----------- — has been installed in accordance with the provisions of the Town of Barnstable Board f H lth �Izl ate Well Protection Regulation as described in the application for Well Construction Permit No.U ®yted------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE --- __ Inspector-----------_.--__—__ —_-----___-- 04 Fee----- ------------ 4 BOARD OF HEALTH s TOWN O.F BARNSTABLE ZippCication fibrVell Conoruct ion Permit Application is hereby made for a-pe`i it t Construct (J ), Alter ( ), or Repa' ( )an individual Well at: , Location — dI _— — Asses..,,Map and Parcel -- ddress Installer — Driller) Address _ Type of Building Dwelling Other - Type of Building-=--__—__--__— No. of Persons--- _-_____.__—_—__—_____. Type of Well SCE Ub �Je,___ _ Ca acit Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The " Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Signed _ —___— _ Z � date 17 Application Approved B �i''��f�W`--� y/� � %�� PP PP Y � �.- r P-'�-"'-'- > t (date I � �- Application Disapproved for the following reaso , '• -.-- � a-°I t f• �:� 5 � — _----.______--- - / -- --�—V''�--- date '---/t �/ / Permit No. � � _�___ Issued--_ //�_I -------- -------- J date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (J), Altered ( ), or Repaired ( ) Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health P "vate Well-Protection L� _ Regulation as described in the application for Well Construction Permit No. �--� -_,,-� R Dated------_-----_-__-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C e NSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ____— ___ _ Inspector i BOARD OF HEALTH TOWN OF BARNSTABLE t_ ' Yell Congtruct ion Permit �.-- 0qr No. ----- --------- Fee----------------- Permission is hereby granted to Construct (✓), Alter ( ), or Repair ( ) an Individual Well at: No. 20—Ge 11;r� cUasv�sa lol.L Street as shown on! th :a plication for a Well Construction Permit No.- ---- Dated----f -- '�!-/x11 -- __ � � ; / ------ .----- DATE /) f �oard of Health TOWN OF BARNSTABLE ATION c__7R r�l f 1 C,s f`(,� S # r;15 F VILLAGE rn Sic,bCe ASSESSOR'S MAP&PARCEL 'S NAME&PHONE NO. Y i GL X-t L I L'I� SEPTIC TANK CAPACITY /CXD v LEACHING FACILITY:(type) 7:1�fl IfrtA?yrS. (size) NO.OF BEDROOMS J OWNER PERMIT DATE: rd 'l` Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 11 ice. . . . . . . . . . . f r f f f r r r r f.f f ff.r f J f rr, r f f f•� f f f f f f \ \ \ \ tt \ \ \ \ \ \ \ Front of House a 43 27 42 .r.T 4 211"1 - 051 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,- Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 every page. City1rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the �. computer, r,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name f� 189 Cammett Road _ Company Address Marstons Mills MA 02648 City/Town State Zip Code 508-428-1779 S1 12855 Telephone Number License Number LU �- B. C6rtification I certify.that I have personally inspected the sewage disposal system at this address and that the cD information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site ® a sewage�d;i'sposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of �- LA.- Title 5,1(3'1'0 CMR 15.000). The system: c_�: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Q .A _ 1, Iv4 �� . October 6, 2011 Job# 11 178 In ector's ignat Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. !Sins•11110 Title 5 Official inspection Form.Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 — every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time. Leaching system shows no signs of surcharge or saturation. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15ins-1 Ill 0 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of.Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts ` w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is Barnstable MA 02630 October 6, 2011 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: 17 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than.100 feet but 50 feet or more from a private water supply well**. Method used to determine distance:. **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of,a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 — _ every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No 9 ❑ Pumping information was provided by the owner, occupant, or Board of Health ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? EJ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the maintenance of subsurface sewage disposal systems? proper 9 P Y The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ®' ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue [ approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readin s, if available last 2 ears usage d 210,000 gal. _ 9 ( Y 9 (gpd)): 288 gpd. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: I t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Geldi!ng Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 _ every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped one year ago. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ®- Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and t maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ' ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name - information is required for Barnstable MA 02630 October 6, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed November 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 30" feet Material of construction: ® concrete ❑ metal ❑ fiberglass [].polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) U Yes ❑ No Dimensions: 8.5' long x 5.2'wide- 1000 gal. ` Sludge depth: 2 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6' Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees were intact and clear. Grease Trap (locate on site plan): Depth below grade: feet Material of construction.- El concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum`thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 . October 6, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present. Liquid level was at bottom of outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 every page. City/Town State Zip Code - Date of Inspection D. System Information (cont.) Type: ❑' leaching pits number: ® leaching chambers number;4 Four Infiltrators.- ❑ leaching galleries number: ❑; leaching trenches number, length: ❑ leaching fields . number, dimensions: ❑: overflow cesspool number: ' ❑` innovative/alternative system Type/name of technology: i Comments (note condition of soil, signs of Hydraulic failure, level'of ponding, damp soil, condition of vegetation, etc.): SAS showed no signs of saturation or surcharge. Area of SAS was probed with no evidence of saturation found. I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration » Depth-top of'liquid to inlet invert Depth of solids layer • Depth of scum layer _ d Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 20 Gelding Circle Property Address Phillip Arsenault _ Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions. Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11110 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault_ Owner -- _._. .. . _.. _. --- ---------------- Owner's Name information is Barnstable _ MA 02630 October 6, 2011 required for _...--._ . _ .._..-.- _--_. _ _--- - every page. City/Town State_ . Zi-p Co_de_ —Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® Ihand-sketch in the area below ❑ drawinq attached separately Front of House 43 27 42 f41i 4 • A M Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 Gelding Circle Property Address Phillip Arsenault _ Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 _ every page. City/Towri State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 30+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with,local excavators, installers- (attach documentation) ® Accessed USGS database -explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 25 and topo map shows property at el. 100. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 t " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 20 Gelding Circle Property Address Phillip Arsenault Owner Owner's Name information is required for Barnstable MA 02630 October 6, 2011 _ every page. City/Towr. State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF;BARNSTABLE LOCATION 'o-y e! /dam,oti� C;2 e SEWAGE # o$! 7) ILLAGE �!� 2 .✓ 1<a .�1� ASSESSOR'S MAP& LOT 2 2-7-6-1 INSTALLER'S NAME&PHONE NO. A SEPTIC TANK CAPACITY b 1 EACHING FACILITY: NO.OF BEDROOMS -3 BUILDER OR OWNER PERMITDATE: �� COMPLIANCE DATE: 3 l� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �r q q3 40 P�Q PJo. u 3! ., ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migpogal *pgtem Con!5truction Permit Application for a Permit to Construct( )Repair cl_�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components, . Location Address or Lo No. wner's Name,Address and Tel.No. Assessor's Map/Parcel, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o 7 3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(� Other Typeg of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -3 :> ® gallons per day. Calculated daily flow 3 �7.3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 9 l)t)y Type of S.A.S. Description of Soil Ge r✓ Nature of Repairs or Alterations(Answer when applicable) E /��9 �✓ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' this Board of Heal . Signed / Date Application Approved/by Date t Application Disapproved fort following reasons Permit No. 0 11T Date Issued ------- -- --- - -- -- — �_�----- ----- ----- - - ——————— --- ._'^sx-.,.�.«...tip,-r.�.us,�.-.,- ..-• .,,..,• . .._...-41.w+...:;gy... �� .� r. Y+ �au ,r.- -•'-•.� �',+Ga'nr'„,.F'�v,+mw�rn.........r�,� ..- ..•^t, Ali 100 Fee 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes SLIC HEALTH DIVISION -TQWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for i0igpoga1 *pgtem Conaruction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon{ ) ❑Complete System ❑Individual Components Location Add ss or L hNo wner's Name,Address and Tel.No. ze Assessor's Map/Pazcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: i Dwelling No.of Bedrooms -�t Lot Size sq.ft. Garbage Grinder j Other Type of Building s. °d'No. of Persons Showers( ) Cafeteria( -) Other Fixtures . Design Flow > gallons per day. Calculated daily flow 33 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 0 �� Type of S.A.S. Description of Soil r"� Nature of Repairs or Alterations(Answer when applicable) Sir ��j'`� ,»✓ r Date last inspected: 3 Agreement: f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been.issu y this Board-of Health. /; j; Signed Date V,/ `"� j Application Approved by n �/"' Date aJ U u/ Application Disapproved for th following reasons Permit No. a-U U 7 Date Issued 13 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( Upgraded( ) Abandoned( )by /" 12- e ''i D 1)✓Idr t i/.G,. at J cc U has b n construct ) 3 m a cord nce with the provisions of Title 5 and the for Disposal System Construction Permit No. 7Uu-! _y 7 rdated L� Installer , �� Designers The issuanc t e t shall not be construed as a guarantee that the s tem wilkniction as jLgodd. Date } F Inspector hV. No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS lwi5po5al *pgtem Congtructiou Permit Permission is hereby granted to Construct. ,)Repair( )Upgrade( )Abandon System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons uction must be completed within three years of the date of t 's e t. Date: (3 �' A roved b pP Y TOWN OF BARNSTABLE LOCATION 2y ��' C.2 e SEWAGE # VILLAGE �!� 2 ,✓s ?.�.�J ASSESSOR'S MAP& LOT 2 INSTALLER'SsNAME&PHONE NO. A �" /3 �2 SEPTIC TANK CAPACITY--, ,-s 7' o 0 2> LEACHING FACILITY: (typef'�•�'� -<,��', Tat a ze) NO.OF BEDROOMS BUILDER OR OWNER /�` �c�s Alt 2 PERMITDATE:1 COMPLIANCE DATE: 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200'feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 . q3 0 POCLI, 2 Town of Barnstable P�pFtHE Tpy Regulatory Services Thomas F.Geiler,Director BARNSTABLE, � pMASS. �0 Public Health Division rFD ;�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Se-FT- 13 2 Designer: D- -A gD,-- y,,t Installer: Address: . P-D- Box 11?l Address J3o x On `2 / v GZ ,V S,r was issued a permit to install a (date) (installer) septic system at C(RCLIe- based on a design drawn by (addr ss) I �''b dated ��/0'� (designer) T certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & lions. Plan revision or certified as-built by designer to follow. � ��" ' ST.o moo`' DARR U P E E N .1 A0 (Installer's Signatur �< �T SGISTE�a n� gN/TAR\P V esigner's ignature} (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTEL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form L C A T 10 N S E*E7.A G E P E R'tI I T p 0. N6 C i z C L f, t VILLAGE -- RlcARAJ L 1�: INSTA LLER'S N A M E 8 "ADORESS cc R UICDE R OR OWNER _.. r. S �x DATE PER°MIT ISSUED DAT E COMPLIANCE ISSUED � ` ,� ,ti, •� �� _ y � �, ! __, �a .. �. .� , .�-,Y ,: ,. -��,� ..ram o,. n,� NO7 _ F�$. ...'.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Nam,' ............. F.. . ,Apure#inn for Diipaiia1 Wnrko Tomilrnr#ion ranfit Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal !� ystem at• I L � .....�� ....e � ... °r ......� �?. ................................. Location-Address or L�t No. --._......�� ............ ....-- ��4f��e� �� Ow er e Address Installer Address dType of Building Size Lot............................Sq. feet U oms___..._..__Dwellng— o. of _.._.Expansion Attic (/h Garbage Grinder (We), U pa., Other—Type of Building .....&OA. ,'5�.... No. of persons........................:... Showers ( ) — Cafeteria ( ) a Other fixtures . --------•-•-• ......•--•-•--.. ... .. Design Flow......_...._ Sr. __ __ _gallons per person per day. Total daily flow..._..._Z. jO...._ W g - -- -jig P P P Y Y dons. WSeptic Tank I Liquid capacity. . _._ allons. Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—Nq. .................... Width_......._._.._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.`_..:_(/..._____... Diameter.._. ..i.s�... Depth below inlet................ Total each ar `, - /..sq. ft. Z Other Distribution box ( ) Dosing nk ) �a �. . . Percolation Test Results Performed by.__ ___ _._. �R..__...q40.? ... Date.-1....f......... .......... Test Pit No. 1................minutes per inch Depth of Test Pit....... ....�Drept�hto ground water......................... Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ AdDescri Description of Soil -----......r --- as �� --........ . --- ----- -=� =. U ------------------------------------------------------ -•....... -------------•-•--------------------------------------------------------------------------------------------•----------------------------------------------................... ................ V Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------•------------------------------------------------------------------------••••••-•.....-••••••••----------••-•-•••••-•--•••-•--••-•--•--••••-•-•-••-••--•••••••-•-.....--••.•-•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITNLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the board of health. Sig d•--- •-•---•---•---_.. ..�� .J�..f . Date Application Approved By...... 1144 -. ••••-- ------ Date Application Disapproved for the following reasons--------------•--------------------------- :...._._. ------------------------------------------------------------------------------------------------------ ----- � :.. s - .......................... sue ._....._-_---- •--......--------•-•--•--•D--a•--E------- y Permit No. Date N®................ ..:. F .... ..... THE COMMONWEALTH,OF MASSACHUSETTS. BOAR® OF ,HEALTH .�.� Application is hereby made for a Permit to Construct (i ) or Repair ;( ) an Individual`•Sewage D> posalY, System at •/-• A .. SS.U-'Ky. .fW ¢ b ®.:� ad......ti, d E�.A� .s<'�i«. .. 'lr.: �.�• .: Location-Address or Lot No a .d~:ij�'.`��.'�`.�,.�$..� � � .....: J �"�!� �2?s f�...�d f a >a O er ape ✓ Address W ,tr f� * v.. .................... �'.�•e' � s [ .5e!. ` !.:. 3 a :: . Installer Address - d Type of Building Size Lot.......... r___ _______Sq feet aDwelling—No. of Bedrooms ___ __ Expansion Attic (eta Garbage Grinder a Other—Type of Buildi>g __.__ ,' ffw•".____ No. of persons_ Showers ( ) Cafeteria ({ d Other fixtures - ------ ................................................................................................... ti W %.'Qesign Flow........... 3..... ""gallons per person per day. Total daily flow........0 ,a.4•__-:•- _ :gallons: Ri Septic Tank I-Liquid capacity/0—:gallons., Length................. Width................ Diameter_______ _:_ Depth W x Disposal Trench N ___._____ Widt :__ ____ Total Length Total leaching area__:__ sq. ft. Seepage Pit No Dlameter___ _2: _._. Depth below inlet:___._p ________ Total. ea hi ar _ - . sq ft. z Other Distribution box ( ) Dosing�•_tank,. ) � � • '-' Percolation Test 'Results: Performed by_..tll�__ _. .t '.._.-. _ Date ...................' Test Pit No. 1________________minutes per inch Depth of Test P --------- _:__ Depth to ground water - Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water Descrs tion.of'Soll 1 x, -- W U Nature of Repairs or Alterations—Answer when applicable_.___:___ __:::..._._ _:____: __:_ ........................... ,. Agreement: The undersigned agrees` to install the aforedescribed Individual Sewage Disposal System in'accor'dance with ' the provisions of TIT?.;,.. 5 of the State Sanitary Code=The undersigned further agrees not:to place the"system;>n, operation until a Certificate of Compliance has been sued by the board of health. ` Sig d.__ d` :- ' _ „ ............... , f 10 Application Approved B ,or Date Date Application Disapproved.f or the following,reasons:.................................................. •••. •••--- ---••-... -•:...- -- ........................................ Date Permit No •-•............................. -•--•- . ••---- Issued _.. `.-- •---- ----- Date , THE COMMONWEALTH OF MASSACHUSETTS :BOARD OF'! HEALTH - t. r .. K� i {s,.a� S Trrfifarfttr `oaf f our0fiattr THIS IS TO CERTIFY,'That the Individual Sewage Disposal System.constructed ( ); or Repaired,( ) by-•-•---•--- __- .off. " ................................... Installer has been installed in accordance with the provisions of T r 5oC The State Sanitary Code as described in the application for.Disposal Works Construction Permit No __..___� __ __.___. darted_w-___ . _:::. ►_` : __::____... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEIN W111. FUNCTION,SATISFACTORY. jS� DATE............../.:....:La.............�_......._.......----------•---• Inspector.......... --- ....... ........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, No1� .% ... ........... f......OF...-. ' .,�r.`. � . .... FEE +7aI or w Permission s hereby granted .................... to Coristru� or Repair ndividua e)N,a Dispos' ystem atNo... . __.. .. 1' - ........ -•----•- -•...................................... et as shown on the application for Disposal°•-',Works Construction P t No..._...____ _:. Dated____/2`•4* ... ........ ------•-----_-•-•-- ?_ " d • Board Health DATE.................................................--------.....__....--------•-- FORM 1255. HOBBS & WARREN,. INC.. PUBLISHERS C��=lG1�l pQ,TA I->d I L`( 1 Loaf./ b G n —,n `f 1 -tai— I G TA+J►C = �30 . f�G % a 11-9�j 6.F USA- 1 �Op 6�.L.. SPOT At_ PIT - '= 1c>p SF j $a�TTO Vl pQE1� C�G SF. I 4. SD Sim. ,c 1 .o - 50 C-�.?.V. I _ TO r� , TOTAL 'I-->ES1G1J = d25 (9•RD. t �� TaT ,L `C,4,k L--( FLUw = 33D 6.F D. Pr-:�'CDL&TIC,1J QATE : � ILS "LMI O. 02 ZM ?+ _ TOr 1:'bJ c°oo.o _. <:.�., J^�pe I coo Imo• ' 1 4r�P� DIST. Iw. GAL. 9(�7 -Box J �,6 9 SEvr lc l o' GAL. 4G.0 A FIT w.as►1�� I iCGC7-T11=►GL7 pl-b-r PL A V�J 1 I CGI.Tt F=`( TI-!AT T{-1E l=�,v _�A. 1 1 , NSSWO\Aj .1 PL 6,1,1 R�=t=i V-c►.1C� 1-IE_1,(=t�IJ CC /lr'L`(S �/ IT4� Tt 1` �jIDE l l► �E: /* r A► L-> °,C-FUACI` �'GCvU10E�c►-1TS OF T►IC_ '�%^' -row Q LU J ,/ C7t_A" I%, UOT 'Lt,SCt7 U(-_-1 r-" o,TEev►�L.0 11.1�(L=�.'✓�1=1Ji �ivi /1.=�{ 'Tt�C U�t �t�; 'l,?I-ILIJL-rD AppLIGA.ti,1T r ° G_ U',Li-° Tv i �I l wl Pi I 1 \ }. 6A �` h RA IL fi'OA1� , B 1 �I Ra�.s s9e/3 `� Rio-e LOCUS ._. L 3 T 99 43. R- 4 3 +/— S.. F. ��. ;irc)0L.L = ! R! EXISTING PATIO i { PROPOSED 16X20 GAR PORCH IJI `. 54 .,- 49 d;- _ f j n INC �I P O r 43 I J a [I 94 110 I PROPOSED GA 5 `96,� SEPTIC COMPONENT LOCATIONS TAKEN FROM AS-BU1L T CARD. � @� S 83°47'25'W I� ZONE' . RF- 1 SETBACKS i j"•?ONT - 3O. SIDE - 15' REAR m 15' y.` �m s r�SS�y`�j MANK i THE DdvEL L I NG D_FP/CTED ON TH/S 7�HIT NG N> I PLAN WAS LOCATED ON THE GROUND BY SURVEY ON DEC. 19 2011 AND S �P <,'� PLOT PLAN =I e; BR/AN SA41THl 20 GELDING CIRCLEI ASAP 297 PCL 51 EX-1 STS AS ._SHOWN AS _OF THE DATE f s a OF.LOCATION. w ��1YtS7'��L M t I ,7 f 7/zolL SCALE: 1 '-40' JAN. 4r 2012 it THIS PLAN IS FOR PLOT PLAN � PURPOSES ONLY AND NOT FOR i RECORDING, DEED DESCRIPTIONS EAGLE SURVEYING , INC j OR ESTABLISHING PROPERTY LINES. 925 Rout® aA � YormDuthport, MA. 02675 ai (508) 362-8132 i (508) 432-5333 THIS PLAN /S VO/D IF NOT STAMPED AND SIGNED IN RED 0 20 40 BO �e ��mt swsea PROJECT NO. 05-124PP I -n ASSESSORS MAP: 'L97 F � TEST HOLE LOGS- car ` NOTES: 'u B w� PARCEL : 05 ( 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH s SOIL L EVALUATOR: 13�l�{tr �S. BOARD OF HEALTH REGULATIONS. P, S PLAN, I995 MASSACHUSETTS TITLE V & TOWN OF s„ R FLOOD ZONE: 0oo �ftZ/4Q.fl -� woos WITNESS: .tl s r _C REFERENCE: $ILq4y5 DATE: �� 2} THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, WSNu, �� W�O PERCOLATION RATE; 2 rq SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO G.n�s 510I4t LTA-2 =o,7y �f y INSTALLATION. F �o oS wu Room oeo� a TH- I .13,gq ,. TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION �o * caRe3z M ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE 1 R „A � �O`(��f DETERMINATION. PE ,t 5" ` t 4 4) ALE. PIPING TO BE 4" SCHEDULE 40 @ 1/9 "/ FOOT. (UNLESS Fj yOY�S� SPECIFIED OTHERWISE) Spa LOCAT I ON MAP(N T S) '` 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE DISPOSAL. 1"Ct {�q 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) J�19 ( �� MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON rl 5`I7/1, A BASE OF 6"OF CRUSHED STONE. 7) OUSTI W, t.E/4GtF PIT IV PUMP, 8JZ. 10o Ir► Ro�rn �.:Iot.o 8_ wiry who 1501or PROP SEPT ! C °SYSTEM DES ! GN 9 a rJ 1 Ot of P90A� 1.�Iut LOT 1, DWA OF } \ FLOW ESTIMATE BEDROOMS AT 110 GAL/DAY/BEDROOM 3 GAL/DAY '01_1vD SEPTIC TANK / 3�GAUDAY x 2 DAYS - 6&0 GAL • PO USE I 1 GALLON SEPTIC TANK- _ , � CN � �,_ �s�Ny '�.P L.�tc.E w/ t15o0 6ro.Sepnc, µgoy. t'F t'-A�t-Eo iD"cb SOIL:AB ORPT I ON SYSTEM UNvevS IZED. th � CA-PAc t IN Ft l.'*AWK VN 17-5 w 4 SmokE o01! Sr r,e A _I.5'S rbA,re.oN ENrn. tx to.g3'iJX `U A S 1 ')E AREA:L;(Z.B) 2.4-POSO 2_1x Z,, s; p '7 y - 1 �f•'t Bc TTOM AREA: 2S x ra.83 x 0 .7Y = 2zzq 4D i Ora 34 Gpo 4 SEPT I C SYSTEM SECTION 7336 6FC> TOT-- (01.15 b D'f �in t s4 ✓aoG� ( +irmal( 14- t1 r Dss qo,� qb / 1000_ GAL gQ,5q �' d, fkp SEPT I C TANK �,• lG,ielS� III _1 AtJ /f sad_. _ �j�ll��,1� ��Q. •"�s4A si" nn LeAc4iltic etip Pizot tj:g�Ctj r S. q2 or- sn�oc,� Ec. : 8Z. y •66 �jµoF Iz 3�$" Doi gy SITE AND SEWAGE PLAN YER LOCAT I ON : 20 6eUA4 04c -E i NO. 1140 �2 1/bI� �"SVIISLZI. Mk n aqa sTEaN 14� WOWStm�. PREPARED FOR : GCvSKR N,TAR�� a ^ lie 34,. 48 ck A&,i4 CoNS77 y(-Ro - DARREN M. MEYER, R.S. SCALE 43 PINE STREET DATE: 3a 0 J pcz�C�G S•N�H I WI Co _ DUXBURY, MA 02332 E1- W DATE HEALTH AGENT (781)585-M3